<section class="scrollable wrapper">
	<div class="row">
		<div class="col-sm-12 col-md-offset-0">
			<section class="panel">
				<header class="panel-heading font-bold">Form Tambah Siswa</header>
				<div class="panel-body">
					<form class="bs-example form-horizontal" data-validate="parsley" action="<?php echo site_url('smn-admin/aset_fasilitas/save'); ?>" method="post">
						<div class="line line-dashed line-lg pull-in"></div>
						<div class="form-group">
							<label class="col-lg-2 control-label">Nama</label>
							<div class="col-lg-10">
								<input type="text" class="form-control parsley-validated" data-required="true"  name="nama">
								<?php echo form_error("nama")?>
							</div>
						</div>
						<div class="line line-dashed line-lg pull-in"></div>
						<div class="form-group">
							<label class="col-lg-2 control-label">NISN</label>
							<div class="col-lg-10">
								<input type="date" class="form-control parsley-validated" data-required="true"  name="nama">
								<?php echo form_error("nama")?>
							</div>
						</div>
						<div class="line line-dashed line-lg pull-in"></div>
						<div class="form-group">
							<label class="col-lg-2 control-label">Tempat Lahir</label>
							<div class="col-lg-10">
								<input type="text" class="form-control parsley-validated" data-required="true"  name="nama">
								<?php echo form_error("nama")?>
							</div>
						</div>
						<div class="line line-dashed line-lg pull-in"></div>
						<div class="form-group">
							<label class="col-lg-2 control-label">Tanggal Lahir</label>
							<div class="col-lg-10">
								<input type="date" class="form-control parsley-validated" data-required="true"  name="nama">
								<?php echo form_error("nama")?>
							</div>
						</div>
						<div class="line line-dashed line-lg pull-in"></div>
						<div class="form-group">
							<label class="col-lg-2 control-label">Jenis Kelamin</label>
							<div class="col-lg-10">
								<select class="form-control" style="width:100%">
									<option value="">-- Pilih Jenis Kelamin --</option>
									<option value="1">Laki - laki</option>
									<option value="2">Perempuan</option>
								</select>
							</div>
						</div>
						<div class="line line-dashed line-lg pull-in"></div>
						<div class="form-group">
							<label class="col-lg-2 control-label">Alamat</label>
							<div class="col-lg-10">
								<input type="text" class="form-control parsley-validated" data-required="true"  name="nama">
								<?php echo form_error("nama")?>
							</div>
						</div>
						<div class="line line-dashed line-lg pull-in"></div>
						<div class="form-group">
							<label class="col-lg-2 control-label">Agama</label>
							<div class="col-lg-10">
								<select class="form-control" style="width:100%">
									<option value="">-- Pilih Agama --</option>
									<option value="1">Islam</option>
									<option value="2">Kristen</option>
									<option value="2">Kristen</option>
									<option value="2">Hindu</option>
									<option value="2">Budha</option>
								</select>
							</div>
						</div>
						<div class="line line-dashed line-lg pull-in"></div>
						<div class="form-group">
							<label class="col-lg-2 control-label">Email</label>
							<div class="col-lg-10">
								<input type="text" class="form-control parsley-validated" data-required="true"  name="nama">
								<?php echo form_error("nama")?>
							</div>
						</div>
						<div class="line line-dashed line-lg pull-in"></div>
						<div class="form-group">
							<label class="col-lg-2 control-label">No. Telepon</label>
							<div class="col-lg-10">
								<input type="text" class="form-control parsley-validated" data-required="true"  name="nama">
								<?php echo form_error("nama")?>
							</div>
						</div>
						<div class="line line-dashed line-lg pull-in"></div>
						<div class="form-group">
							<label class="col-lg-2 control-label">No. HP.</label>
							<div class="col-lg-10">
								<input type="text" class="form-control parsley-validated" data-required="true"  name="nama">
								<?php echo form_error("nama")?>
							</div>
						</div>
						<div class="line line-dashed line-lg pull-in"></div>
						<div class="form-group">
							<label class="col-lg-2 control-label">Orang Tua / Wali</label>
							<div class="col-lg-10">
								<select class="form-control" style="width:100%">
									<option value="">-- Pilih Orang Tua / Wali --</option>
									<option value="1">Karwo</option>
									<option value="2">Jarwo</option>
									<option value="2">Budi</option>
									<option value="2">Habidin</option>
								</select>
							</div>
						</div>
						<div class="line line-dashed line-lg pull-in"></div>
						<div class="form-group">
							<div class="col-lg-offset-2 col-lg-10">
								<button type="submit" class="btn btn-primary">Tambah</button>
								<button type="button" class="btn btn-white" onClick="window.history.back();">Batal</button>
							</div>
						</div>
					</form>
				</div>
			</section>
		</div>
	</div>
</section>